Safety and feasibility of a cervical laminectomy in patients with traumatic spinal cord injury

Background: A cervical laminectomy can prevent further deterioration and sometimes even provide neurological improvement in patients with traumatic spinal cord injury (TSCI) without signs of instability. Although this procedure is frequently performed, the feasibility and in particular the safety of a decompression through a laminectomy after TSCI remains disputable. We sought to assess the safety and feasibility of a cervical laminectomy in patients with TSCI and without instability. Methods: This single-center retrospective cohort study included patients who underwent a cervical laminectomy at the Erasmus Medical Centre, Rotterdam, from January 2018 to December 2020, due to a recent trauma with surgery in <24 h after diagnosis. The primary outcome included mortality, reoperation rates and neurological outcomes. Results: Of the 51 trauma patients who had undergone a cervical laminectomy, 43 patients were included. Those patients had a mean age of 66.0 years (SD = 12.2 yr) and 37 (86.0%) patients were male, with a median ASA score of III. 3 patients (6.98%) died within 30 days, with all deaths not directly associated with the surgery, but to the preceding trauma. Two (4.65%) patients needed a reoperation. 31 of the 43 (72.1%) patients showed neurological improvement postoperatively. Of the patients who did not improve neurologically, only 1 patient experienced new neurological impairments. Median postoperative length of stay in our hospital was 92.5 h (3.9 days). Conclusions: Our results confirm the safety and feasibility of acute cervical laminectomy in patients with TSCI without suspicion of segmental instability, even with high preoperative risk scores.